Postoperative residual curarization at the post-anesthetic care unit of a university hospital: A cross-sectional study

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• 作者：Fredy Ariza^a ; ^b ; ^{fredyariza@hotmail.com} ; Fabian Dorado^a ; Luis E. Enrí ; quez^b ; Vanessa Gonzá ; lez^b ; Juan Manuel Gó ; mez^b ; ^c ; Katheryne Chaparro-Mendoza^a ; Á ; ngela Marulanda^a ; Diana Durá ; n^b ; Reinaldo Carvajal^c ; Alex Humberto Castro-Gó ; mez^b ; Plauto Figueroa^b ; Hugo Medina^b
• 关键词：Neuromuscular blocking agents ; Anesthesia ; Perioperative period ; Prevalence ; Delayed emergence from anesthesia
• 刊名：Colombian Journal of Anesthesiology
• 出版年：2017
• 出版时间：January-March 2017
• 年：2017
• 卷：45
• 期：1
• 页码：15-21
• 全文大小：792 K
• 卷排序：45

文摘

Postoperative residual curarization has been related to postoperative complications.ObjectiveTo determine the prevalence of postoperative residual curarization in a university hospital and its association with perioperative conditions.MethodA prospective registry of 102 patients in a period of 4 months was designed to include ASA I–II patients who intraoperatively received nondepolarizing neuromuscular blockers. Abductor pollicis response to a train-of-four stimuli based on accelleromyography and thenar eminence temperature (TOF-Watch SX®. Organon, Ireland) was measured immediately upon arrival at the postanesthetic care unit and 30 s later. Uni-bivariate analysis was planned to determine possible associations with residual curarization, defined as two repeated values of T4/T1 ratio <0.90 in response to train-of-four stimuli.ResultsPostoperative residual curarization was detected in 42.2% of the subjects. Pancuronium was associated with a high risk for train-of-four response <0.9 at the arrive at postoperative care unit [RR:2.56 (IC95% 1.99–3.30); p = 0.034]. A significant difference in thenar temperature (°C) was found in subjects with train-of-four <0.9 when compared to those who reach adequate neuromuscular function (29.9 ± 1.6 vs. 31.1 ± 2.2; respectively. p = 0.003). However, we were unable to demonstrate a direct attribution of findings in train-of-four response to temperature (R2 determination coefficient = 0.08%).ConclusionsA high prevalence of postoperative residual curarization persists in university hospitals, despite a reduced use of “long-lasting” neuromuscular blockers. Strategies to assure neuromuscular monitoring practice and access to therapeutic alternatives in this setting must be considered. Intraoperative neuromuscular blockers using algorithms and continued education in this field must be priorities within anesthesia services.